Compliance and adherence of patients in the treatment of acute lymphoblastic leukemia

173 xxx both display linear pharmacokinetics in the dose range(s) usually employed. Furthermore, the good central nervous system (CNS) penetration of both Bu and Mel and their relative non-overlapping clinical toxicity profiles should make this combination an effective, high-dose chemotherapy regimen. In the autologous setting,(4,5) BU plus Mel as conditioning regimen prior to ASCT has been administered in patients affected by MM, lymphoid malignancies and AML in first CR. Results from various studies(4,5) including combinations of these drugs, suggest that the BU-Mel regimen is effective and well tolerated. The most relevant extra-hematological adverse event was oral mucositis. The two formulations of BU (oral and intravenous) did not show any difference either in the toxicity profile or for the anti-leukemic activity. Few data are available on the use of this conditioning regimen in allogeneic stem cell transplantation. In some studies, intravenous Bu in combination with Mel was administered in ALL and advanced lymphoma. This combination appeared to be well tolerated with disease control as good as would be expected with a TBI/Cy regimen. Furthermore, the use of the Bu-Mel-ATG (antithymocyte globulin) regimen was reported as conditioning for unrelated umbilical cord blood transplants in pediatric patients. Again, the regimen was well tolerated and the engraftment of granulocytes was achieved in a good proportion of patients with a satisfactory overall survival. Taken together, these data suggest that the role of the Bu-Mel combination as a conditioning regimen prior to HSCT is promising in patients with hematological malignancies.